Abstract:Phase 1 of this study evaluated the perception of pain in 50 patients undergoing peripheral venous catheter insertion without the use of a local anesthetic. Phase 2 evaluated perceived pain in 50 patients who received intradermal lidocaine before the i.v. catheter was inserted. The researchers found that lidocaine injected intradermally before placement of an i.v. catheter resulted in significantly lower self-reported pain perceptions (p < 0.01). No additional time (determined in intervals of 15 minutes) was r… Show more
“…Update searches (September 2014 and August 2015) identified six additional studies, giving a total of 37 primary research studies. Thirty two were randomised controlled trials [ 1 , 13 – 17 , 27 – 52 ], four were controlled trials [ 53 – 56 ]} and one was a survey [ 57 ]. Fig.…”
Section: Resultsmentioning
confidence: 99%
“…The primary outcome, pain, was measured in a variety of ways including: a visual analogue scale (VAS) ( n = 22 studies [ 1 , 14 – 17 , 27 , 30 – 32 , 35 , 37 , 39 – 41 , 43 , 44 , 46 – 49 , 51 – 53 , 56 ]), a numerical rating scale ( n = 6, [ 13 , 29 , 34 , 38 , 50 , 54 ]), Wong Baker Faces ( n = 1, [ 28 ]) and, other ( n = 4 [ 30 , 33 , 36 , 45 ]). Four studies reported that participants had been given pre-medication prior to PVC [ 29 , 42 , 45 , 47 ].…”
BackgroundPeripheral venous cannulation is an everyday practice in hospitals, which many adults find painful. However, anaesthesia for cannulation is usually only offered to children. Inadequate pain relief is not only unpleasant for patients but may cause anxiety about further treatment and deter patients from seeking medical care in the future. The aim of this study is to discover the most effective local anaesthetic for adult peripheral venous cannulation and to find out how the pain of local anaesthetic application compares with that of unattenuated cannulation.MethodsThese aims are addressed through a systematic review, network meta-analysis and random-effects meta-analysis. Searching covered 12 databases including MEDLINE and EMBASE from 1990 to August 2015. The main included study design was RCTs. The primary outcome measure is self-reported pain, measured on a 100 mm visual analogue scale.ResultsThe systematic review found 37 includable studies, 27 of which were suitable for network meta-analysis and two for random-effects meta-analysis. The results of the network meta-analysis indicate that none of the 17 anaesthetic considered had a very high probability of being the most effective when compared to each other; 2 % lidocaine had the highest probability (44 %). When the anaesthetics were compared to no treatment, the network meta-analysis showed that again 2 % lidocaine was estimated to be the most effective (mean difference −25.42 (95 % CI −32.25, −18.57). Other members of the ‘caine’ family were also estimated to be more effective than no treatment as were Ametop®, EMLA® and Rapydan® patch. The meta-analysis compared the pain of anaesthetic application with the unattenuated pain of cannulation. This found that all applications of local anaesthetic were less painful than cannulation without local anaesthetic. In particular a 1 % lidocaine injection was estimated to be −12.97 (95 % CI −15.71, −10.24) points (100 mm VAS) less painful than unattenuated cannulation.ConclusionsThe pain of peripheral venous cannulation in adults can be successfully treated. The pain of application of any local anaesthetic is less than that of unattenuated cannulation. Local anaesthetic prior to cannulation should become normal practice and a marker of high quality care.Protocol registrationThe protocol for the larger study was registered with PROSPERO no. CRD42012002093.Electronic supplementary materialThe online version of this article (doi:10.1186/s12871-016-0252-8) contains supplementary material, which is available to authorized users.
“…Update searches (September 2014 and August 2015) identified six additional studies, giving a total of 37 primary research studies. Thirty two were randomised controlled trials [ 1 , 13 – 17 , 27 – 52 ], four were controlled trials [ 53 – 56 ]} and one was a survey [ 57 ]. Fig.…”
Section: Resultsmentioning
confidence: 99%
“…The primary outcome, pain, was measured in a variety of ways including: a visual analogue scale (VAS) ( n = 22 studies [ 1 , 14 – 17 , 27 , 30 – 32 , 35 , 37 , 39 – 41 , 43 , 44 , 46 – 49 , 51 – 53 , 56 ]), a numerical rating scale ( n = 6, [ 13 , 29 , 34 , 38 , 50 , 54 ]), Wong Baker Faces ( n = 1, [ 28 ]) and, other ( n = 4 [ 30 , 33 , 36 , 45 ]). Four studies reported that participants had been given pre-medication prior to PVC [ 29 , 42 , 45 , 47 ].…”
BackgroundPeripheral venous cannulation is an everyday practice in hospitals, which many adults find painful. However, anaesthesia for cannulation is usually only offered to children. Inadequate pain relief is not only unpleasant for patients but may cause anxiety about further treatment and deter patients from seeking medical care in the future. The aim of this study is to discover the most effective local anaesthetic for adult peripheral venous cannulation and to find out how the pain of local anaesthetic application compares with that of unattenuated cannulation.MethodsThese aims are addressed through a systematic review, network meta-analysis and random-effects meta-analysis. Searching covered 12 databases including MEDLINE and EMBASE from 1990 to August 2015. The main included study design was RCTs. The primary outcome measure is self-reported pain, measured on a 100 mm visual analogue scale.ResultsThe systematic review found 37 includable studies, 27 of which were suitable for network meta-analysis and two for random-effects meta-analysis. The results of the network meta-analysis indicate that none of the 17 anaesthetic considered had a very high probability of being the most effective when compared to each other; 2 % lidocaine had the highest probability (44 %). When the anaesthetics were compared to no treatment, the network meta-analysis showed that again 2 % lidocaine was estimated to be the most effective (mean difference −25.42 (95 % CI −32.25, −18.57). Other members of the ‘caine’ family were also estimated to be more effective than no treatment as were Ametop®, EMLA® and Rapydan® patch. The meta-analysis compared the pain of anaesthetic application with the unattenuated pain of cannulation. This found that all applications of local anaesthetic were less painful than cannulation without local anaesthetic. In particular a 1 % lidocaine injection was estimated to be −12.97 (95 % CI −15.71, −10.24) points (100 mm VAS) less painful than unattenuated cannulation.ConclusionsThe pain of peripheral venous cannulation in adults can be successfully treated. The pain of application of any local anaesthetic is less than that of unattenuated cannulation. Local anaesthetic prior to cannulation should become normal practice and a marker of high quality care.Protocol registrationThe protocol for the larger study was registered with PROSPERO no. CRD42012002093.Electronic supplementary materialThe online version of this article (doi:10.1186/s12871-016-0252-8) contains supplementary material, which is available to authorized users.
“…This percentage is within the range of previously reported failure rates of from 9% to 56%. [3][4][5]8,9 Unsuccessful IV insertion attempts can adversely affect patients' attitudes about the nurse and perceptions about the nurse's caring. Patients' perceptions of nurse caring are strongly linked to their beliefs about the nurse's skill in technical procedures such as IV insertion.…”
“…Studies that have published cannulation success rates have found this figure in control groups to range from 71-100%. 3,5,7,10 The success rate in the control arm of this study is at the lower end of this range. There are several reasons for this.…”
Intravenous cannulation is a commonly performed procedure. This study aimed to determine whether the success rate and pain of intravenous cannulation is affected by prior injection of intradermal lidocaine. Intravenous cannulation was performed twice in 45 healthy volunteers. Intradermal lidocaine was administered prior to one of these cannulations. The outcome measures were success or failure of cannulation, and pain of cannulation, measured with a 100 mm visual analogue pain scale. The success rate of intravenous cannulation with and without prior intradermal lidocaine was 54% and 76%, respectively. The difference was 22.0% (95% CI 1.5-27.8%; P = 0.03). Log-linear analysis for three-way interaction between the variables (outcome, vascular condition and use of lidocaine) showed a significant influence of vascular condition on outcome (G(2) 24.6, P < 0.001). The mean (SD) pain scores in the control and intervention group were 34.8 (21.0) and 13.6 (13.2) mm, respectively. The difference between the mean pain scores was 21.2 mm (95% CI 15.1-27.3 mm). In conclusion, the success rate of intravenous cannulation may be reduced with the use of intradermal lidocaine, but success rate is primarily dependent on vascular condition. Intradermal lidocaine achieves a clinically significant reduction in the pain of intravenous cannulation.
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